Chirurgie à coeur ouvert en République démocratique du Congo : réalité ou utopie/cas clinique d'une indication avortée

La chirurgie à coeur cardiaque est un mode de traitement des pathologies cardio-vasculaires et médicales. Elle n'est plus pratiquée en République Démocratique du Congo (RDC) depuis plusieurs décennies. Nous rapportons le cas clinique d'une fillette de 12 ans admise aux Cliniques Universitaires de Kinshasa pour atélectasie totale du poumon gauche, soignée auparavant comme une tuberculose pulmonaire, et dont le bilan a révélé un faux anévrysme géant de l'aorte descendante. Devant cette urgence, la seule thérapie possible, la chirurgie cardio-vasculaire, n'a pas été possible suite au manque d'équipements adéquats en RDC. Elle est décédée 4 jours après son diagnostic pendant qu'elle réalisait les formalités pour une évacuation sanitaire à l'étranger. La prise en charge d'urgence, notamment la chirurgie à coeur ouvert reste encore un challenge dans notre pays. Elle passe nécessairement par l'équipement de nos hôpitaux, surtout ceux de niveau tertiaire, et par l'amélioration du niveau socio-économique de nos populations

Child morbidity and mortality due to cerebral malaria in Brazzaville, Congo. A retrospective and prospective hospital-based study 1983-1989.

This study was conducted in all four hospitals of Brazzaville, the capital of the Congo in order to assess the trend in malaria morbidity, the frequency of cerebral malaria and the related mortality between 1983 and 1989 in Brazzaville children. For the period 1983 to 1987 the study was retrospective, based on records. For the period 1988 and 1989 a prospective study was carried out in the two main hospitals in which a system for reporting cases of cerebral malaria was set up. This was completed by a retrospective analysis of data similar to that carried for the previous years. The population of Brazzaville children aged between 0 and 14 years and the distribution by district were estimated from the 1984 official census taking the annual demographic growth to be 5%. The results show a marked increase in hospitalizations for malaria, noticeable since 1985, and which now account for about 50% of the overall non-surgical hospitalizations. The number of cases of cerebral malaria and related deaths have probably increased. However, these severe forms of malaria were relatively rare. Indeed, in 1988 and 1989, for the 0-4, 5-9 and 10-14 year age groups, the annual incidence rates of cerebral malaria were estimated at respectively 240, 61 and 13 per 100,000 and the related mortality rates at respectively 58, 5 and 1 per 100,000. No obvious relationship was found between the intensity of malaria transmission, which varied considerably according to the district, and the level of mortality from cerebral malaria.

[Efficacy of quinine in children hospitalized for malaria attacks in Brazzaville (Congo) in 1989]. / Efficacite de la quinine au cours des accès palustres de l'enfant hospitalisé à Brazzaville (Congo) en 1989.

The efficacy of quinine prescribed to children from Brazzaville hospitalized for acute malaria (temperature over 38 degrees C, P. falciparum parasitaemia over 10,000/mm3, no other obvious disease; the reason for hospitalisation often being digestive or neurological disorders) was assessed. Quinine was administered by perfusion: 25 mg/kg/day for at least 3 days. Associated treatment (sulfadoxine-pyrimethamine combination in 80% of the cases) was given at day 3. Blood was taken at day 0, and before discharge (usually between days 3 and 5). Thick Blood Smears (TBS) were examined for a volume of blood corresponding to 300 leucocytes. Antimalarials had been taken in 60% of the cases (chloroquine in 67% of the cases, quinine in 10%). Antimalarials were not assayed in the sera. In 68 cases of non pernicious malaria, no obvious cases of resistance were observed. TBF were negative in 49 out of 52 cases at day 3, and 11 out of 12 at day 4 and in five out of five cases at day 5. In 96 cases of pernicious malaria, only one case was suspected of being resistant, with a weakly positive TBS at day 7. 13 children died but all in the first three days without suspicion of resistance. Apyrexia was observed before day 4 in 89% of the cases; only one case of fever at day 7. TBS were negative before day 4 in 97% of the cases. So, at the dosage of 25 mg/kg, quinine was found to be very effective in the Congo in 1989 against both pernicious and non pernicious malaria.

[Clinical presentation of non-pernicious malaria attacks in patients hospitalized in Brazzaville (Congo) in 1989]. / Présentation clinique des accès palustres non pernicieux hospitalisés a Brazzaville (Congo) en 1989.

The clinical manifestations observed in 102 malaria patients (parasitaemia of over 8,000 Plasmodium falciparum/mm3) hospitalized in 1989 in Brazzaville (Congo) were analyzed after ruling out the cases of pernicious malaria. The clinical picture was fever, stomach upset with headache and musculo-articular pain as in classical cases. In children these manifestations were frequently associated with convulsions. Diarrhoea was not uncommon in young children. Vomiting was frequent in both children and adults. Splenomegaly and hepatomegaly were closely related to age. In these subjects, chemoprophylaxis was rare in children, practically non-existent in those aged over 5 years. However, presumptive treatment and self medication was usual regardless of age.

The epidemiology of measles in a partially vaccinated population in an African city: implications for immunization programs.

A large outbreak of measles was reported in Pointe-Noire, Congo, between October 1984 and March 1985. An investigation was conducted to determine the epidemiology of measles in this community in which, in 1985, 54% of the children 12-23 months of age had documented evidence of vaccination against measles. The investigation included hospital and clinic record reviews and a community survey. Measles has been continuously transmitted in Pointe-Noire since at least 1979, with seasonal epidemics. In early 1984, the expected epidemic did not occur, and at least 1,000 measles hospital admissions and 100 measles deaths were prevented. Between October 1984 and March 1985, 1,942 measles cases were hospitalized, of which 306 (15.8%) died. During the epidemic, the proportion of nonpreventable cases (cases occurring before nine months of age) was 17%, reflecting the change in age distribution of measles cases in childhood since the immunization program started in Pointe-Noire in 1982. From the community survey, it was estimated that 13% of all children under age five years acquired measles in Pointe-Noire in 1985. Vaccine efficacy was calculated from community and hospital samples to be between 78% and 87%. Our findings suggest that increasing vaccination coverage levels to well above 50% is necessary to substantially reduce measles morbidity and mortality in African cities.

[Prevalence of bilharzia antibodies in the pediatric population of the village of Pointe-Noire (Republic of the Congo)]. / Prévalence des anticorps antibilharziens dans la population infantile de la ville de Pointe-Noire (R. P. Congo).

Thirty clusters of children have been tested for schistosomiasis serology in the town of Pointe-Noire (Popular Republic of Congo). Out of 360 patients, 3 presented antibodies against schistosomiasis. The antibodies prevalence of this parasitosis is 0.83% +/- 0.008% which is very low as compared to other areas of the country.

[Evaluation of immunological and entomotological indices of yellow fever in Pointe-Noire, People's Republic of Congo]. / Evaluation des indices immunologiques et entomologiques de la fièvre jaune à Pointe-Noire, en République populaire du Congo.

The authors report the results of a serological sample survey managed to evaluate the prevalence of two types of yellow fever antibodies, connected with an entomological survey, in the town of Pointe-Noire in the People's Republic of Congo. According to the high rate of non protected people, the high level of entomological indices and the characteristics of local environment, this densely populated town may be considered as an area exposed to a potential hazard of a yellow fever outbreak. A vaccinal strategy ought to be planned according to this situation.